This is a 30-year-old woman, G4P3, admitted at 10 weeks for lower abdominal pain and a intermittent vaginal bleeding (spotting). At 8 weeks, a sonographer diagnosed a twin dichorionic, diamniotic pregnancy. We performed a vaginal scan that showed two intra-uterine embryos (one live and one dead fetus) and between the uterus and the left ovary, we diagnosed an ectopic pregnancy. There was a small amount of blood in the pouch of Douglas. A laparoscopy was done a few hours later. The diagnosis was confirmed and a left salpingectomy was performed. The right fallopian tube was normal.

Vaginal scan at 10 weeks showing the two intra-uterine embryos.

Pregnancy implanted between the uterus and the left ovary. Note the small amount of blood in the pouch of Douglas.